New research at The University of Nottingham is calling for changes to a government scheme which engages community nurses in the prevention of child abuse and neglect in the home as part of a maternal and child health care programme.
The study, published online by the Journal of Public Health, has found that despite being set up to help reduce the numbers of child abuse cases, the £10 million Family Nurse Partnership will only be able to tackle around 10% of families involved in child maltreatment.
And, the researchers say, by using different, less common risk factors to identify vulnerable children, the scheme could reach three times the number of abusive families using a similar number of health visitors.
The research was carried out by Professor Kevin Browne, Professor of Forensic Psychology and Child Health, and Vicki Jackson, Lecturer in Forensic Psychology, at the University’s Centre for Forensic and Family Psychology
Professor Browne said: “The claims made about FNP to reduce child maltreatment in England have been over exaggerated. Careful consideration needs to be given to other prevention programmes that are tailored to the needs and vulnerabilities of the family.”
The Family Nurse Partnership (FNP) was an American idea adopted by the past two UK governments who invested £10 million in a pilot scheme in ten areas of England. It was a response to the increasing numbers of children being maltreated or neglected. A year ago nearly 170,000 children in England were registered as ‘children in need’ because of abuse or neglect.
The scheme is designed to offer disadvantaged new parents tailored help and support from a specialist nurse in the home in the weeks and months after childbirth. The aim has been to give many more vulnerable children across the country a better start in life and to teach new parents the skills to cope with parenthood and childrearing.
The Government recently published a national review on health visiting and families at risk, as well as revisions in primary health-care services to promote child health and welfare. The report, Early Intervention: The Next Steps, authored by Nottingham North MP Graham Allen, acknowledged that a proactive approach is crucial to the prevention of child abuse and neglect. He championed the use of the American-style FNP on the basis that in the States there was evidence to suggest that it leads to a reduction in child abuse and neglect and improves outcomes for children in vulnerable families. Families ‘in need’
The evaluation of the impact of the FNP scheme by the researchers in the Centre for Forensic and Family Psychology, based in the University’s School of Community Health Sciences, found that there are currently around 315 health visitors implementing the programme, a figure which is set to rise to around 585 by 2015.
However, with Government figures suggesting that the true number of families ‘in need’ is close to 30,000 every year, in reality around 1,350 health visitors would be needed, close to two and a half times projected targets.
By targeting first-time, young vulnerable mothers with low socio-economic status – the current criteria for the FNP – the programme is only reaching around one-quarter of families likely to benefit and the study estimates that it is missing 90% of child abuse and neglect cases.
The authors claim that using specific known risk factors, such as a history of domestic violence or where parents had themselves been abused as a child, would be far more effective in identifying vulnerable children than targeting just first-time mums from poorer backgrounds.
Data from a previous study involving Professor Browne, which looked at an English population of 14,252 families, showed that families with a history of domestic violence were 23 times more likely to abuse their child under 5 years of age.
Highest relative risk
It also revealed that 2% of parents in the general population reported that they had been abused or neglected as a child, yet one in five (20%) of abusive parents reported this characteristic. This compares to young, first-time mothers with socio-economic problems who were present in 30% of the population but just 10% of abuse cases.
Using information from these more predictive risk factors, combined with national birth rates, could allow the Government to implement a modified FNP using less health visitors to reach double the number of abusive families or an almost equal number to those currently in place to detect 30% of child abuse and neglect cases.
Professor Browne added: “It is vital that families with a history of domestic violence are not ignored by health professionals as it regularly presents the highest relative risk for child maltreatment. It is also cited in 46% of child abuse and neglect referrals to police child protection units.”
The paper, Community Intervention to Prevent Child Maltreatment in England: Evaluating the Contribution of the Family Nurse Partnership by Professor Kevin Browne and Dr Vicki Jackson, is available online on the website of theJournal of Public Health: http://jpubhealth.oxfordjournals.org/content/early/2013/04/28/pubmed.fdt046.full
University of Nottingham